Provider Demographics
NPI:1689322976
Name:TACUSALME AXIS CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:TACUSALME AXIS CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RABBONNI
Authorized Official - Middle Name:
Authorized Official - Last Name:TACUSALME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-664-2268
Mailing Address - Street 1:915 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2206
Mailing Address - Country:US
Mailing Address - Phone:415-664-2688
Mailing Address - Fax:415-729-1679
Practice Address - Street 1:915 IRVING ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2206
Practice Address - Country:US
Practice Address - Phone:415-664-2688
Practice Address - Fax:415-729-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty